Provider Demographics
NPI:1184730053
Name:SHAW, GEOFFREY SYDNEY (MD)
Entity type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:SYDNEY
Last Name:SHAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 WAUKEGAN RD
Mailing Address - Street 2:STE 120
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093
Mailing Address - Country:US
Mailing Address - Phone:847-716-1302
Mailing Address - Fax:847-716-1312
Practice Address - Street 1:191 WAUKEGAN RD
Practice Address - Street 2:STE 120
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093
Practice Address - Country:US
Practice Address - Phone:847-716-1302
Practice Address - Fax:847-716-1312
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
F72221Medicare UPIN
IL335810Medicare ID - Type Unspecified